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New Member Introductions If you just joined, please introduce yourself here. Please add a signature describing your spinal history (use the "User CP) and ask us how we can help you get started.


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  #1  
Old 06-03-2012, 05:08 PM
YZ2U YZ2U is offline
Junior Member
 
Join Date: Jun 2012
Posts: 5
Default New Guy on the Forum...

Hi All... I'm considering ADR for single level at L4/5 for DDD. I have an annular tear and recently had a Discogram to confirm what we already knew. I just got my denial letter from Anthem BC in CA for my ProDisc-L, but immediately working on the appeal and plan to file an IMR with the State. I found a nice reversal from a 2007 S.C. Administrative Finding reversing BCBS denial for a members prescibed ADR and the decision seems to be the exact information everyone should use for their states IMR process. Especially when dealing with BCBS organizations...

Juliana Antonelli vs. SCBCBS
SC Administrative Law Court - Decisions


Good luck all!

I.
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  #2  
Old 06-06-2012, 08:38 PM
Harrison's Avatar
Harrison Harrison is offline
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Join Date: Oct 2004
Posts: 7,016
Default

Thanks for posting and sharing. What are your next steps? Pls tell us a bit more about your spinal health. And your history --- what brought you here?

http://www.adrsupport.org/forums/f58...-health-11053/
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"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
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  #3  
Old 07-02-2012, 11:24 PM
YZ2U YZ2U is offline
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Join Date: Jun 2012
Posts: 5
Default Next Steps...

I've appealed Anthem BC's denial with the assistance of Synthes PAL, but as a Disabled Veteran I will also be requesting preauthorization from my local VA hospital to have them cover the procedure by my outside Specialist. Although I appreciate the assistance of the PAL folks, I have to say that I'm not very impressed by their processes and sense of urgency.

Just my initial thoughts...

I've read that the procedure is covered by the VA for single level, but it has to be done state-side. That said it's been a month since I've submitted the request and will be making follow-up calls after the 4th of July holiday to check on the status. Just like every other government agency you have to stay on their butts to get things done. In the mean time I'll continue to research the procedure and it's pros/cons, but specifically the ProDisc L.

We'll see...
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  #4  
Old 07-25-2012, 12:32 PM
christinlal christinlal is offline
Senior Member
 
Join Date: Nov 2010
Posts: 103
Default Blue Cross Blue Shield Worldwide

not only approved than denied a one level adr (figured out how to deny due to the hardware the surgeon wanted to use - too new and deemed experimental.) Denied fusion.

Now, I am also having to self pay for my cervical discogram (another 10K) because Blue Cross Blue Shield also thinks it is experimental == and only pay for lumbar discograms.

Soooo glad I have paid premiums my whole life.
Christine
__________________
12/2008 early am gym class-something very wrong
2/2009 DDD 4 herniated cervical discs
3/3009-8/2009 8 spinal epidurals, pt
09/2009 C6/7 Prodisc C ADR
11/2010 facet joint inj 12/2010 Rhizotomy TBI Dr. Cottingham months of relief
05/2011 facet Joint Inj 06/2011 Rhizotomy
7/2011 Dr. Zigler TBI, facet block and Discogram
11/18 surgery with Dr/Mr. Boeree..Thank God.
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bcbs, blue cross denial, cervical disc replacement, insurance appeal, rhizotomy, surgery preauthorization

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